| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
574 |
573 |
$24K |
| V2020 |
Frames, purchases |
655 |
647 |
$13K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
286 |
280 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
554 |
548 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
395 |
393 |
$10K |
| V2025 |
Deluxe frame |
118 |
118 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
104 |
104 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
42 |
42 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
137 |
137 |
$0.00 |
| 92015 |
Determination of refractive state |
54 |
54 |
$0.00 |